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REDUCTIO AD ABSURDUM. |
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Outright
contradiction ! Looks absurd, but true all the same.
Medical scientists are talking about prolonging life and
increasing life span etc. in every conceivable forum. I
wonder if anyone has really looked at this seriously. We
have achieved increased life expectancy at birth even in
the poorer countries in the last fifty odd years, but to
say that we have increased life span is far from the
truth. Many times even scientists fall into this trap of
giving opinions without hard data to support their
opinions. In many areas in medicine dogma and opinions
abound. Depending on the stature of the person dogmas
stick for very long times to the detriment of genuine
truth, hindering progress in our knowledge.
Even in other sciences this kind of absurdity exists. Let
us examine quantum physics. In 1905 in the German journal
Annalen der Physik, Albert Einstein, who was then
a patent clerk aged 26, wrote an article explaining how
certain solids generate electric currents when struck by
light, the photoelectric effect. Here Einstein reversed
the hundred year old accepted theory that light travels
as a wave. His proposition was that light
sometimes acts like a stream of particles. In 1923
the French theoretical physicist Louis de Broglie twisted
the same argument by saying that electrons could act like
waves or particles. New theory of quantum electrodynamics
changed this by showing how electrons interact with
photons. Interestingly another famous physicist Richard
Feynman thought that nobody could understand quantum
physics properly. Students were taught that electrons
were either waves or particles depending on the
experimental apparatus used. They have all agreed now
that the particles and the waves are but
the extremes of a continuum. In every field of human
knowledge clarity is not an alternative to truth.
Let us come back to our question on hand. Is there a
biological limit to human life span ? Is it the same for
all animals or is it different for man? What are the
evidences? I had written earlier about the great English
actuary, Benjamin Gompertz, who lived in the early part
of the nineteenth century. This man conceived a human
life curve and documented it properly, but the whole
thing was lost after his death. Recently they have been
able to discover the same from Nottingham where he lived.
Surprisingly it compared very well with the present data.
In 1825 or so Gompertz wrote that human mortality
increases with age in a geometric proportion, doubling
every eight years, between the ages of twenty and eighty
years. Gompertz died before he could prove his
hypothesis. Another biologist Raymond Pearl, thought that
Gompertz was right, by his experiments on Drosophila in
the year 1926, nearly hundred years after Gompertz.
Recently in a study sponsored by the US dept. of Energy,
Bruce A Carnes and Jay Olshansky showed that there is a
limit for human life span and it is not possible to
extend it any further. They have appreciated
Gompertz’s phenomenal hypothesis. In a lighter vein
Bernard Shaw in his book Doctor’s Dilemma
said " Do not try to live for ever you will
certainly not succeed." If, as we believe, medical
science is able to keep all people alive for ever what
will happen to this world ? The truth is that medicine
has been and will be able to do exactly what Hippocrates,
the father of modern medicine wrote thousands of years
ago " cure rarely, comfort mostly, but console
always." Medicine should concentrate its efforts to
add life to patients’ years and not vice versa.
Unfortunately it does not make good business sense. We
should tell people that we have increased human life
span. If people regularly get themselves checked up they
could avoid fatal diseases, detect the latter in their
presymptomatic stage for complete cure etc. Like in
physics this aspect of medicine is only an opinion and
not the truth. Hans Christian von Baeyer, the professor
of physics in Virginia, writing a book on
Thermodynamics said that clarity is not an
alternative to truth.
The truth is that human life span has been fixed over
thousands of years of evolution and can not be extended
now. Biologically a human being is of no use genetically
for the species after the reproductive age. Women after
menopause have higher incidence of degenerative diseases.
Penile artery is a very good guide to the state of
coronary artery patency. As long as a man gets a good
erection, it is said, one could roughly estimate his
coronary vessel patency. Man is born with only two basic
traits, the instinct of self preservation and that of
procreation. All others are acquired after birth. What
then is the basis of the dubious claim that we have
extended human life span. I can not better what Olshansky
said about that question. " We now have what could
be described as `manufactured survival time’ ."
Allthough I have been writing about this for a long time,
this was again brought home to me in the case of patient
of mine and a good neighbour, which is worth reporting.
This was an elderly lady who lost her husband after a
prolonged illness. Both of them had very bad diabetes,
hypertension and coronary artery disease. After the
husband’s death she was very much depressed and her
disabilities worsened significantly. She was in renal
failure for sometime. The latter worsened and she was
vomiting daily. We have been able to manage
symptomatically and try and control her pressure, sugar
etc. The relatives wanted her to be taken to a
metropolitan city for better care and she landed, very
much against her wish, in a five star hospital there.
They started dialysing her daily, her condition kept
getting worse day by day. She was in the intensive
therapy unit (imagine the cost!). She developed complete
heart block while she was being dialysed, but did not
have any symptoms. She was in bed with a heart rate of
forty per minute. But they wanted to pace her and she had
a permanent pace maker put in. Next day she had some
chest pain and it was decided to do coronary angiography
on her. Thank God , some sense prevailed and they
deferred it temporarily. Eventually she died there.
Luckily the bill did not give a heart attack to the near
and dear ones ! This is where I keep worrying about our
system. What was the need to put a permanent pace maker
for an old lady in severe renal failure, heart failure,
diabetes etc. She was in her terminal stages. How on
earth does the coronary anatomy help to keep this lady
comfortable? These and many other questions keep begging
answers from thinkers in this field.
No one has done any research to show " how longer
life by itself is desirable, unless it is accompanied by
comparable gains in its intrinsic quality. " Should
market forces alone guide our clinical judgement ? Should
medical teaching change to accommodate human aspects of
patient care in the syllabus? Long life ! - It is a
favorite toast. It has its blessings and also its curse.[index]
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